PICOTis an acronym for a formula mostly used in healthcare and scientificresearch to develop logical questions containing specific components.The goal for applying the PICOT strategy is to narrow down availablestudy material accessible to specific literature that is relevant tothe research question at hand. This paper elaborates on the use ofthe formula and explains the meaning of the acronym by providing anexample. The target question should translate the care processinvolved in identifying misdiagnosis into a PICOT statement.


Forthe task, ‘P’ represents patient or the human element of theresearch, ‘I’ the intervention necessary, ‘C’ a comparisonbetween one mode of intervention or another, ‘O’ the expectedoutcome and ‘T’ the timeframe for consideration after applicationof the intervention (Thammasitboon &amp Cutrer, 2013).Forinstance, the sample question of choice explores the impact ofpeer-reviews on diagnoses on patients with diabetes by primary carephysicians in the reduction of diagnostic error results after initialdiagnosis.

Identificationof PICOT Statements

  1. What is the impact of peer-reviews on results by primary care physicians following initial diagnosis of patients compared to results with no reviews in the reduction of diagnostic error results?

  2. Are peer-reviews by primary care physicians more accurate in reducing diagnostic error in results for patients after initial diagnosis compared to outcomes with no reviews?

Thetwo statements differ in the sense that the first one focuses on theintervention while the second one centers on the test.

ConceptualOutcome v Operational Outcome

Aprominent difference between a conceptual outcome and an operationalone is that the former seeks to prove the validity of a researchconcept while the latter aims at establishing the viability ofmethods, data, and concepts in practical application (Zwaan, 2012). Aconceptual outcome is often a result of analysis of several theorieson the subject matter, whose justification depends on theavailability of evidence from daily operations. Such theories oftenarise from literature reviews (Graber et al., 2012). A researcheressentially chooses literature discussing concepts that support hisor her own to lend credence to the theory under development as avalid idea. On the other hand, conceptual outcomes are the result ofstatistical analysis of data from similar research using the sameformula, albeit with minor differences such as calculation of marginsfor error. The goal for a conceptual outcome is to provide a viableand practical option that the researcher can use in his or her dailyoperations with a specific degree of certainty regarding thepossibility of success. The application of theoretical variables inthe development of conceptual outcomes causes vagueness anduncertainty of terms that often limit the reliability of the resultin practical application.

Thedifference between the two sets of outcomes matters because it guidesthe researcher depending on his or her objective for the study(Nendaz &amp Perrier, 2012). Using conceptual method requires nounit of measurement to develop an outcome. However, using such amethod on research that requires a large degree of certainty beforeimplementation of the findings is likely to make application of theresults in daily practice disastrous. Operational outcomes aredistinguishable from conceptual ones by specific measuring methodsand scales for certainty of results (Minue, 2014). Below are twoexamples of such differences. The first is indicative of anoperational outcome while the second shows a conceptual one.

  1. The use of peer-reviews by primary care physicians for patients reduces diagnostic errors after initial diagnosis significantly.

  2. The use of peer-reviews by primary care physicians for patients reduces diagnostic errors after initial diagnosis by 20%.


Zwaan,Thijs, and Wagner (2012) provide a good example of an article thatconstitutes a meta-analysis of the first PICOT statement. The authorsreview diagnostic reasoning after initial diagnosis of patients, withthe help of medical information and statistical data obtained afterexamination of patients. The goal of the research findings is toestablish whether a link exists between diagnostic reasoning duringinitial patient diagnosis and diagnostic errors after review of theinformation. The research includes peer-reviews of the initialdiagnosis and medical data after tests to determine the extent oferrors.

Nendazand Perrier (2012), on the other hand, offer a systematic review ofthe PICOT statement. The authors conduct a study of the methods andmechanisms applicable in reducing diagnostic errors and flaws.Peer-reviews comprise one of the applicable methods that the researchsuggests for minimization of diagnostic errors. The objective of theresearch is to highlight methods that help in the prevention ofdiagnostic errors and flaws.

Graberet al. (2012), Minue et al. (2014), as well as Thammasitboon andCutrer (2013) provide reports related to the PICOT statement. Thereports essentially consist of literature reviews and those of datafrom secondary sources. The goal of the articles is to compilesufficient information relating to the topic to support their thesisstatements. A common presumption identifiable in the reports is thatinterventions such as peer-reviews, systematic checks, and review oftest results are significant in the reduction of diagnostic errorsafter the initial diagnosis of patients.


Graber,M., L., Kissam, S., Payne, V.,L., et al (2012). Cognitiveinterventions to reduce diagnostic error: a narrative review. BMJQual. Saf. 21(7):535-537

Minue,S.,Bermudez-Tamayo, C., Fernandez, A., et al (2014). Identificationof factors associated with diagnostic error in primary care. BCMFam. Pract. 15:92

Nendaz,M. &amp Perrier, A. (2012). Diagnostic errors and flaws in clinicalreasoning: mechanisms and prevention in practice. SwissMed Wkly 23:142

Thammasitboon,S. &amp Cutrer, W., B. (2013). Diagnostic decision-making andstrategies to improve diagnosis. Curr.Probl. Pediatr. Adolesc. Health Care43(9): 232-241

Zwaan,L., Thijs, A., Wgner, C., et al. (2012). Relating faults indiagnostic reasoning with diagnostic errors and patient harm. AcadMed 87(2):149-156